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We study lossy-to-lossless compression of medical volumetric data using three-dimensional (3-D) integer wavelet transforms. To achieve good lossy coding performance, it is important to have transforms that are unitary. In addition to the lifting approach, we first introduce a general 3-D integer wavelet packet transform structure that allows implicit bit shifting of wavelet coefficients to approximate a 3-D unitary transformation. We then focus on context modeling for efficient arithmetic coding of wavelet coefficients. Two state-of-the-art 3-D wavelet video coding techniques, namely, 3-D set partitioning in hierarchical trees (Kim et al., 2000) and 3-D embedded subband coding with optimal truncation (Xu et al., 2001), are modified and applied to compression of medical volumetric data, achieving the best performance published so far in the literature-both in terms of lossy and lossless compression.